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The role of an ethical culture for the prevention and recovery of “second victims”
  1. William A Nelson1,
  2. Suzanne C Beyea2
  1. 1
    The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA
  2. 2
    Dartmouth Centers for Health and Aging, Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA
  1. Correspondence to Dr William A Nelson, Dartmouth Medical School-The Dartmouth Institute for Health Policy & Clinical Practice, HB 7251, 35 Centerra Parkway, Lebanon NH 03766, USA; william.a.nelson{at}

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The Natural History of Recovery for the Health Care Provider “Second Victim” After Adverse Patient Events (see page 325) provides some helpful insights into the nature and complexity of the consequences clinicians experience when they are involved in an “unexpected event”. The clinicians’ experiences described in this analysis reflect the overall culture of their healthcare organisation and its programs for safety and quality. Importantly, this organisation’s Office of Clinical Effectiveness observed and then assessed the suffering experienced in numerous caregivers (second victims) who were involved in a patient safety event. These research findings provide clear evidence of this particular healthcare organisation’s commitment to its patients and caregivers and creating an ethical, high-quality practice environment and a culture of safety.

These findings reveal the significant anguish associated with unexpected events. The suffering occurring after a medical error can create significant moral distress as well as potentially being a factor in fostering the medical error. Moral distress is a concept, first noted by Jameton1 in the nursing ethics literature. Moral distress occurs when a healthcare professional, in a given situation, knows or believes she knows what the ethical appropriate action is but is unable or feels constrained from acting because of obstacles, such as lack of supervisory support and/or organisational constraints.2 The result of the phenomena can increase staff stress, decrease morale, foster job turnover and diminish the organisation’s culture. Furthermore, the impact of recurring ethical issues and the attendant moral distress on staff can create an economic burden to the organisation.3

Moral distress may have contributed to an error if—for example, staffing …

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  • Competing interests None declared.

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